These researchers looked at adolescents referred to a tertiary center for scoliosis
concerns, and found that overweight and obese adolescents presented with significantly
larger spinal curves at a higher degree of skeletal maturity, meaning their conditions
would be less amenable to non-surgical intervention.

The authors point out that physical exam techniques, such as Adam's forward bend test, are technically more difficult in obese patients, making it more difficult to screen
this population for scoliosis. They suggest more liberal use of a scoliometer, or perhaps screening radiographs, in this population.

I'd like to highlight 2 study design issues that can limit the utility of the information.
First, note that the study was performed at a tertiary care center on patients referred
specifically for scoliosis concerns. That's a very different group of patients than
what a primary care provider sees, where for the most part scoliosis is uncovered
via routine screening of a presumably health population. That's called spectrum bias, most often seen when a study originates in a tertiary center and therefore usually
is focused on patients with more severe forms of a disease.

Second, I was puzzled to see that the investigators chose to divide their patient
groups into 3 body mass index (BMI) categories: normal weight, overweight, and obese
patients. By doing this, they are taking a continuous variable (BMI) and converting it to an categorical variable. This can sometimes result in lost information that might be informative, and I wish
the authors had presented their rationale for this approach. This is a nuanced point,
I realize, but little things like this always give me pause about the reliability
of a scientific report.

Until we have better prospective studies on screening in primary care, front line
providers should have a higher degree of vigilance for scoliosis in obese adolescents,
and consider more focused screening methods.